EUR/ICP/POLC 02 01 01 ENGLISH ONLY UNEDITED
WHO REGIONAL OFFICE FOR EUROPE ______DEVELOPMENT OF HEALTH ECONOMICS LEARNING MATERIAL
Report on a WHO Meeting
Lund, Sweden 30 September – 2 October 1998
SCHERFIGSVEJ 8 DK-2100 COPENHAGEN Ø DENMARK TEL.: +45 39 17 17 17 TELEFAX: +45 39 17 18 18 TELEX: 12000 E-MAIL: [email protected] WEB SITE: HTTP://WWW.WHO.DK 1999 EUROPEAN HEALTH21 TARGET 18 EUROPEAN HEALTH21 TARGET 18
DEVELOPING HUMAN RESOURCES FOR HEALTH
By the year 2010, all Member States should have ensured that health professionals and professionals in other sectors have acquired appropriate knowledge, attitudes and skills to protect and promote health (Adopted by the WHO Regional Committee for Europe at its forty-eighth session, Copenhagen, September 1998)
ABSTRACT
Health economics and health policy experts met to review nine previously commissioned modules, to determine the need for further modules, and to discuss suitable learning modes. The objective is to generate a set of modular learning materials, through which the basics of the health economics approach can be disseminated to a broad audience in the context of the health for all policy. All the current modules were retained, with some modification of content and style. Eleven additional modules, following the standard format, were identified and authorship proposed. Learning modes and techniques were discussed, and it was noted that different approaches would be needed for different target groups. The modules will be subject to peer review, and feedback will be encouraged from both tutors and target groups. It was agreed that revisions to the current modules would be finalized within a few months, and that the new modules would be prepared before mid-1999. All modules will be reviewed at a progress meeting.
Keywords
TEACHING MATERIALS HEALTH ECONOMICS HEALTH POLICY HEALTH FOR ALL EUROPE
© World Health Organization All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. The Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors are solely the responsibility of those authors. CONTENTS
Page
Background...... 1
Purpose of the Meeting...... 1
Scope and purpose of module development...... 1
Review of existing modules...... 2 Module 1. The interrelationship of health, health care and the economy ...... 2 Module 2. Differing viewpoints of health and economic ministries...... 3 Module 3. Health is everybody’s business ...... 3 Module 4. Reallocation of resources...... 3 Module 5. Expenditure-incomes-revenues identity ...... 4 Module 6. Privatization in health care systems...... 4 Module 7. Economic evaluation ...... 4 Module 8. Policy analysis...... 5 Module 9. Economic modelling...... 5
Proposals for additional modules...... 5
Learning modes and marketing of modules...... 7
Further action...... 8
Main conclusions from the meeting...... 9
Annex 1 Programme ...... 10 Annex 2 Participants...... 11
EUR/ICP/POLC 02 01 01 page 1
Background
The health for all (HFA) policy aims to maximize people’s physical, social and emotional health, and their social and economic contributions. The ethical values incorporated in the concept are acknowledged, for example, in the statement that health is a fundamental human right, as is equity in health, opportunities for participation in health policy, and accountability of decision- makers.
The field of health economics can contribute to the promotion and implementation of HFA policy. It offers a particular framework for thinking, as well as methods of investigation and analysis, and empirical evidence. It is acknowledged that some interest groups will oppose greater transparency in decision-making and evaluation of health policy, but this should not prevent the wider dissemination of the health economics approach.
The objective of this project is therefore to generate a set of learning materials through which the basics of the health economics approach can be disseminated to a broad audience in the context of HFA policy. In the first instance, these learning material will consist of a set of written modules, for use in workshops, seminars and other educational settings. Such a modular approach, consisting of a basic set of core material augmented with current and locally relevant examples, has the great advantage of being flexible over time and settings.
Purpose of the Meeting
A preliminary set of nine learning modules was commissioned from health economics and health policy experts in the summer of 1998. The objectives of the meeting in Lund were to review the current modules and the need for further modules, and to determine the best approach for the development and dissemination of the learning materials. Ten health economics and health policy experts from universities, research and consultancy institutes, and health ministries participated in the meeting (list of participants in Annex 1). Professor Björn Lindgren was appointed Chairperson of the meeting, Dr Herbert Zöllner acted as Secretary and Dr Claire Gudex as Rapporteur.
Scope and purpose of module development
Although the modules can be used for independent study, they are primarily aimed at use in group learning, in shorter (i.e. hours, days), informal courses. The modules should be sufficiently flexible, however, for use either as stand-alone courses or as components of other courses; taught locally or by distance learning; and used at national or international level.
The target audience for the modules is potentially very wide and diverse in terms of educational background, knowledge and understanding of health economics, cultural background, ethical and philosophical values, job requirements, and incentives for learning. It will be necessary to specify the target group in each case, and consequently determine the most relevant setting and mode of teaching, the skills required of the tutor, the level of teaching and types of examples, and the time allotted. EUR/ICP/POLC 02 01 01 page 2
Not all modules will be of relevance to all target groups, and care should be taken to use real-life examples and current political events to catch the attention and interest of participants. Rather than each module having a fixed format, it should be used as a template, where the key issues to be conveyed are first identified and then further material, including examples and case-studies, are added according to the particular setting and target group. With this in mind, most modules will need experienced facilitators. References and a list of further reading material should be provided (and access to these materials ensured). The learning experience will, of course, also be much enriched by the diverse practical experience that participants bring from their own local settings.
Three levels of learning are identified: · forming an appreciation of basic concepts and analytic frameworks; · gaining experience at the appraisal level, leading to the use of analytic tools to examine and judge policies and empirical studies in a local context; and · developing the skills needed to carry out analysis of data and policies, including the development and testing of new methods and strategies.
Different target groups will need skills at different levels. For example, while health ministers would need both appreciation and appraisal skills, other government officials and industry leaders would only need appreciation skills in the first instance. Health care managers would need skills at all three levels.
The survival and further development of the course should be ensured through the involvement and training of local experts.
Review of existing modules
Participants agreed that the current nine modules were extremely well written and form an excellent basis to the course. They provide both stimulating and thought-provoking material, and include a range of learning techniques, including exercises, case-studies and role-play.
The meeting discussed each in turn regarding its potential audience; the ways in which it could be expanded to include other issues or aspects, further evidence and examples; its style and presentation; level of difficulty; and relationship to other modules. Suggested modifications are noted below. Note that these should be read in the light of the additional modules which were later proposed. Some of the content of the new modules may lessen the need for modifications to the current modules.
Module 1. The interrelationship of health, health care and the economy This module could be expanded to include societal and environmental aspects that also affect health, and thus it could also refer to social care as well as health care. There could also be acknowledgement of the system’s dynamic state (i.e. contraction as well as growth can occur), with inequalities of wealth and excluded populations who require very different strategies for health and health care. The case of the Russian economy could be a useful example of the issues.
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Extra modules suggested · Determinants of health · Economies in transition · Social differences in health, health care and health behaviour · Health and politics; economic skills for health policy-makers · Development of health technology
Module 2. Differing viewpoints of health and economic ministries The role-play in this module was greatly appreciated and it was suggested that this could be excellent as a video, although it would also be useful to have course participants act out the roles of health and finance ministers. The language in the role-play should be modified for a more international audience. Since the issues are relevant to all ministries, it was suggested that the title be changed to Health and Other Ministries. There were requests for a more specific argument for the health minister to deliver back to the finance minister, including, for example, how (s)he might bargain with other ministers, perhaps illustrated with health goals rather than budget goals. More direct acknowledgement could be made of the political dimension (e.g. with respect to re-election hopes), and that arguments made are not always rational. A possible further example could be the issues surrounding compulsory medical insurance, highlighting the roles of the different actors and the potential conflicts that can arise between them.
Extra module suggested · Conflicts of interest between national and local government levels
Module 3. Health is everybody’s business This module could place more emphasis on the determinants of health, perhaps through some examples. It could be noted that individuals function in different settings (e.g. family, workplace) and that individuals within a group are different from each other. Social aspects could be included in Fig. 3-1 and the model made more dynamic, reflecting the interactions that occur between ministries. Further suggestions included an examination of French versus Icelandic life expectancy; health inequalities; and an ethical debate, e.g. concerning the euthanasia debate in the Netherlands. Issues could be illustrated through the use of life expectancy (and other) curves on a CD-ROM, drawing on the HFA database.
Extra module suggested · Individual and collective human capital and behaviour; health promotion
Module 4. Reallocation of resources As it stands, this module may be too complicated for many target groups. The message could be clearer and the example simpler. A suggested title change was Value for Money. The module could be expanded to include allocation of resources at individual level (preferences and choices) and allocation by markets. The framework’s dynamic nature could be acknowledged, with respect to population aging, new technologies and new health challenges. A suggested case study was the comparison of the effects of spending money in different areas (including outside health care), to show that there can be very different results depending on where the money goes. It should be noted that it is not just a case of taking resources away from health care, but putting them where they will be of most benefit. A discussion of allocation of resources should probably come before reallocation, suggesting the need for a new module explaining types of efficiency.
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Extra module suggested · Review of types of efficiency (technical, allocative)
Module 5. Expenditure-incomes-revenues identity It was suggested that this module should come earlier in the course, perhaps after the module Health is Everybody’s Business, and that since health care reform is not a main topic in the module it could be left out of the title. The module provides a clear approach to the topic and uses interesting examples. It was suggested that the entity titles be altered to reflect less of a public finance viewpoint, e.g. Financing (revenue) – Production – Income, and that the title of Example 5-2 be changed. The discussion on expenditure could be expanded to prevent the other two issues from dominating, and the importance of the international economy could be mentioned (e.g. pharmaceuticals in the newly independent states). The difficulty of measuring health care production could also be noted.
Extra modules suggested · Budget deficits, deregulation · Management of health care reform
Module 6. Privatization in health care systems Participants felt that the module was biased towards the idea that competition and privatization are never good solutions, and that it could be altered to include different opinions and to acknowledge the value judgements involved and the frequent difficulties in drawing conclusions. The reasons behind a move to privatization could be explained (noting both objectives of equity and efficiency) and there could be further discussion of the delivery side where privatization can have an important role (e.g. in contracting). It may be useful to discuss under which conditions countries can introduce market systems, noting the relevance of evidence, values and objectives. It should be noted that there is also competition inside the public sector, and that economics is only one input.
There could be some discussion of the ways in which the image of the public sector can be improved and maintained, with reference to the need to withstand commercial pressures, to legislate for the regulation of a market-oriented system and to develop national strategies. The arguments could be presented as a debate to flag the main issues even more. A further possible example is the case of the merged public and private insurance systems in the Netherlands.
Extra module suggested · Economics of transition
Module 7. Economic evaluation The module could start by listing the various criteria for evaluation and noting which actors are sensitive to which criteria. It could be expanded to include a discussion of how far data sets and the empirical basis of analyses can be trusted, and how evidence can be pulled from different sources. It could be noted that economic evaluation is multidisciplinary, and that different actors (including health economists) can make different contributions and may also have different interpretations of terms (e.g. “evaluation”). It could also be made clearer that values are being made explicit and that health economics cannot answer all questions, especially where there are political constraints. Further examples could come from areas outside health care, and reference could be made to recent articles in the Journal of the American Medical Association on clinical EUR/ICP/POLC 02 01 01 page 5 decision-making, as well as to the Icelandic requirement for all legislation to be given an economic evaluation before being submitted to Parliament.
Extra modules suggested · Introduction to health economics · Health administration and management
Module 8. Policy analysis The meeting suggested that there should first be a preface to this module, which could come earlier in the course, describing the interrelationship between health policy and health economics. Since the module itself is so different in emphasis from the others, it could come at the end of the course after those dealing more directly with health economic concepts. The module could be expanded to include a discussion of the role of interest groups (e.g. health care professionals) in the development and implementation of guidelines. In Table 8-1, current European issues (including outside health care) could be used as examples in the remaining boxes, reflecting different stages of policy development, for example, Why does the world work the way it does? Does an intervention work? Can the effect be demonstrated or replicated? Can the intervention be broadened nationally? Can we improve effectiveness, efficiency and equity once the intervention is operational? (Based on Nutbeam, D. et al. Journal of epidemiology and community health, 44: 83–89 (1990). In a module targeted at politicians, it might be useful to start with a definition of health policy and then use Table 8-1 to catch their attention. An accomplished moderator would be needed to work through the examples, especially those relating to policy development, where the students are likely to have considerable practical experience.
Extra module suggested · Relationship between health policy and health economics
Module 9. Economic modelling Participants felt that this module would be too technical for some target groups. The key concepts should be sketched out first for those who do not wish to develop more technical skills. The module could be expanded to include more emphasis on the use of sensitivity analysis and further sections discussing data quality and the relationship between correlation and causation. The introduction could also be expanded to include a discussion of the advantages and limitations of using models in general. Table 9-3 could be simplified, perhaps by moving some of the notes into the text.
Extra module suggested · International comparisons
Proposals for additional modules
As indicated in the previous section, the need for further modules became apparent during discussion of the current modules. These related to issues that were not already covered or that deserved their own modules, plus an introductory preface explaining the use of the modules in general, and another relating health economics to HFA. Review of material in two recent publications (Saltman, R. & Figueras, J. European health care reform: analysis of current strategies. Copenhagen, WHO Regional Office for Europe, 1997, and Zöllner, H. & Lessof, S. EUR/ICP/POLC 02 01 01 page 6
Population health: putting concepts into action. Copenhagen, WHO Regional Office for Europe, 1998) generated further ideas.
The proposals for additional modules were discussed in more detail, and a set of 11 additional modules were agreed upon. These, together with their proposed authorship, were as follows: 1. General introduction to modules (a ‘cookbook’), including their potential mode of use and introducing the three levels of learning. Author Greg Stoddart, with review by David Gunnarsson 2. Relationship between HFA and health economics, noting that equity is a fundamental notion in HFA policy; how health economics skills can help policy-makers; an emphasis that economics is not about rationing but optimization; reference to other courses available and mention of the Leonardo da Vinci project. Author John Lavis, with review by David Gunnarsson 3. General introduction to health economics concepts, including definitions of efficiency and equity; perhaps based on the World Bank module. Authors John Lavis and Greg Stoddart 4. Economic and social determinants of health: “Health Capital”. Author Béatrice Majnoni d’Intignano, with review by experts to be determined 5. Individual versus collective behaviour and capital, including efficiency and equity issues and referring to household production function. Author Björn Lindgren and Eva Bondar 6. Appraisal of financing mechanisms for health services, including a comparison of local versus national levels and cross-border issues. Author Panos Kanavos, with review by experts to be determined 7. Managing health care reform: evaluation of available options, including ambulatory and hospital care, alternatives to hospital treatment, and pharmaceuticals. Authors Elias Mossialos (LSE) and Panos Kanavos 8. Economies in transition, including international comparisons. Author Yanis Yfantopoulos, with contributions from Naila Zhuzzhanova and Suszy Lessof (WHO) 9. Health administration and management. Authors John Wyn Owen (Nuffield Trust) and Chris Selby Smith (Australia), with review by David Gunnarsson 10. Development and diffusion of health technology, including technology transfer, health impact assessment and regulation. Authors Michael Drummond and Björn Lindgren, with contributions from Eva Bondar 11. Primary health care, referring to the need for an intersectoral and multidisciplinary approach; including long-term care and implications of an aging population; relationship of primary care to secondary care; substitution; effect of health policies on households and families. Authorship to be decided after Almaty meeting in November 1998.
In view of the likelihood that different modules will be used in different settings, the final modules might be lettered rather than numbered. Some of the content in the additional modules may lessen the need for modifications to the current modules.
Together with the original 9 modules, these additional 11 modules give a total of 20 learning modules. It was suggested that a 21st module could be added, in line with HEALTH21. It was suggested that HELM (Health Economics Learning Materials) was a good acronym for the EUR/ICP/POLC 02 01 01 page 7 project. Once all the modules have been completed, they should be subject to peer review and placed in a logical order so that HELM forms a well structured and coherent set of materials.
Learning modes and marketing of modules
Apart from the subject matter of the modules, there is also the issue of how best to present and market them (Fig. 1). Literature already exists on ways of achieving this (e.g. Soumerai, S. & Avorn, J. Academic detailing. Journal of the American Medical Association, 263: 549–556 (1990).
Fig. 1. Transfer of HFA concepts into “HELM”
HFA
Marketing Creating a climate
Contents TRANSFER GROUP
Learning methods
Technology Availability of EVALUATION instructors
Participants agreed that several learning modes should be catered for. The main use of the modules is likely to be in case-based small-group learning, where participants, having read the background material, meet in a small group to discuss the issues and do the exercises, aided by a facilitator. The modules can also be used in interactive lectures, where no material has been read in advance. In this case, it is suggested that, where applicable, the lecture starts with a current local issue, perhaps using newspaper articles to catch the participants’ interest, with the more formal arguments and definitions of economic terms being presented at the end. A third mode could be a short dinner lecture (e.g. for ministers and industry leaders). Other learning modes should also be used, including role-playing, the use of cassettes, videos, CD-ROMs and the Internet. CD-ROMs are already used in some eastern European countries and a health economics course (Kevin Shoreman, Georgetown University) is already available on CD-ROM. Self- administered computer modules can have a broader diffusion, can achieve more interactive participation, and are likely to be cheaper than meetings. A potential partner could be the European Union, with its Research & Development programme (DG 5, 12, 13).
The potential benefits of involving opinion-leaders were emphasized, although considerable effort is sometimes needed to achieve a sufficient level of information so that the opinion-leader can then present and discuss the issues with his/her own group. When adapting the modules for different target groups, it would also be useful to base them on a key issue that is likely to EUR/ICP/POLC 02 01 01 page 8 stimulate interest among the group. For example, physicians may appreciate an ethical debate on public/private mix or data confidentiality, while industry leaders may find health expenditure a more relevant topic. Some groups may require direct confrontation with issues such as quality and equity, while others would prefer a presentation and discussion of the latest literature and methodology, leaving them to come to their own conclusions. When generating examples for the modules, collaboration with local experts should be sought.
It would be useful to have a list of current health economics training programmes, especially those aimed at the newly independent states and the countries of central and eastern Europe. These would include the training modules on the economics and financing of health care delivery in developing countries, developed by the Economic Development Institute of the World Bank. Information sources include the EUROMET project of Matthias Graf von der Schulenburg (Hanover), and WHO’s Leonardo da Vinci project (aiming to list courses in health economics and health management and to identify the future learning needs of target groups over the next decade).
Once all modules are ready for testing, they could be piloted in two or three countries in order to gain feedback from users. A chat corner on the Internet could both provide the most current versions of the modules with updated data and examplesand allow evaluative feedback. Further marketing of the modules can occur via target groups, journals (e.g. Eastern European journal of public health) and a link with the Observatory page on WHO’s website.
Further action
Having decided to modify the current nine modules and to develop 11 new modules, the participants agreed the following time-frame: · revisions to the current modules to be sent to WHO by Friday 18 December 1998; · the new modules to be sent to WHO by Wednesday 31 March 1999; · all modules, particularly the new ones, to be reviewed at a further meeting provisionally set for 14-15 April 1999.
The authors of the general introductory chapter will need to see the drafts of all the modules before they can finalize their contribution.
Authors will have a chance to comment on any revisions to their modules before wider dissemination, and each module will acknowledge the contributing authors.
Each module will follow the following format as far as possible: 1. a cover page, identifying key messages in the module; 2. tutor’s notes, indicating how the module might be adapted for use by different target groups (Fig. 2) to achieve different levels of skill (appreciation, appraisal, analysis), assuming that modules will be expert-based in the first instance; 3. text with exercises and examples (Béatrice Majnoni d’Intignano offered to provide suggestions for each module of graphs or case studies showing relevant international comparisons or trends); 4. list of references and further reading material (including standard textbooks), indicating where the abstract/full text would be available. EUR/ICP/POLC 02 01 01 page 9
Fig. 2. Target groups for “HELM”
A. Legislative · Health ministry (elected officials, office staff) · Finance ministry (elected officials, office staff) · Other ministries (elected officials, office staff) · Parliamentary parties
B. Administrative · Industry (CEO, small and big business): Health care-related and other industry Other industry · Health care administrators
C. Clinical (health care professionals)
D. Other · General population/local community · Voluntary sector · Patient groups · Academics and researchers
Collaboration: World Bank Sources of information on currently available courses
Peer review will be conducted through internal review from authors’ own institutions, review by members of the various target audiences, and further meetings such as this one in Lund.
The meeting ended with thanks to the organizers of and participants in the meeting, and to the authors of the modules for their considerable and invaluable contributions to a successful meeting.
Main conclusions from the meeting
The initial nine health economics learning modules were highly praised and it was agreed that they form an excellent basis for a course. The efforts involved in preparing these and in meeting to review them have been extremely worthwhile and productive.
The initial set of modules has now been extended to 20 by the proposed addition of 11 new modules. These fill gaps in the coverage of the current material and also provide links with both the existing modules and learning material available elsewhere. In view of the use of the modules as flexible templates for learning, it is likely that most of them will need experienced facilitators.
The health economics learning modules need to undergo a further stage of review and iteration before they can be published. Innovative ways in which the materials can be disseminated and marketed need to be explored further. EUR/ICP/POLC 02 01 01 page 10
Annex 1
PROGRAMME
Wednesday, 30 September 1998 09.00–09.30 Introduction and welcome 09.30–10.30 Scope and purpose of module development 11.00–12.30 (continued) 13.30–15.00 Review of existing learning modules 15.30–17.00 (continued)
Thursday, 1 October 1998 09.00–10.30 Review of existing learning modules 11.00–12.30 Ascertaining gaps 13.30–15.00 (continued) 15.30–17.00 Bringing in European evidence
Friday, 2 October 1998 09.00–10.30 Steps for completing the first set of modules 11.00–11.30 (continued) 11.30–12.30 Testing and marketing of modules: audiences and methods 13.30–14.30 (continued) 14.30–15.00 Conclusions EUR/ICP/POLC 02 01 01 page 11
Annex 2
PARTICIPANTS
Temporary Advisers
Dr Eva Bondar Tel.: +36 12702001 Coordinator, Soros Foundation Project on Fax.: +36 11208423 Health Research in Economics e-mail: [email protected] 5, Gellerdhegy Utce H-1016 Budapest Hungary
Professor Michael F. Drummond Tel..: +44 1904 430 000 Director, Centre for Health Economics Fax.: +44 1904 433644 University of York e-mail: [email protected] Heslington York, YO1O 5DD United Kingdom
Mr David Á. Gunnarsson Tel.: +354 5609700 Secretary General Fax.: +354 5519165 Ministry of Health and Social Security e-mail: Laugavegur 116 IS-150 Reykjavik Iceland
Dr Panos Kanavos Tel.: +44 171 9556802 LSE Health Fax.: +44 171 9556803 London School of Economics and Political Science e-mail: [email protected] Houghton Street WC2A 2AE London United Kingdom
Dr John N. Lavis Tel..: +1 905 525 9140 Assistant Professor Fax.: +1 905 546 5211 Centre for Health Economics and Policy Analysis e-mail: [email protected] Department of Clinical Epidemiology McMaster University Health Science Centre, Room 3H27 1200 Main St. West Hamilton, ON, Canada
Professor Reiner Leidl Tel..: +49 731 5031030 Department of Health Economics Fax.: +49 731 5031032 Universität Ulm e-mail: [email protected] Helmholtzstr. 22 D-89081 Ulm Germany
Professor Björn Lindgren (Chairperson) Tel..: +46 40 33 19 69 Department of Community Medicine Fax.: +46 40 33 62 15 EUR/ICP/POLC 02 01 01 page 12
Health Economics and Biostatistics e-mail: [email protected] Malmö University – Medical Research Centre Carl Gustafs väg 33 S-205 02 Malmö Sweden
Professor Béatrice Majnoni d'Intignano Tel..: +33 1 4277 1633 Faculté de sciences économiques et de gestion Fax.: +33 1 4325 2450 Université de Paris XII e-mail: 12 rue Debelleyme F-75003 Paris-Créteil France
Professor J.N. Yfantopoulos Tel..: +301 6840212 Professor, Health Economics and Social Policy Fax.: +301 684 0212 University of Athens e-mail: [email protected] Sahtouri 12 Str., 152 32 Halandri – Athens Greece
Dr Naila Zhuzzhanova Tel..: +7 3272 491 766 Health Policy and Management Department Fax.: +7 3272 491 766 Kazakhstan School of Public Health e-mail: [email protected] Utepov 19A 480060 Almaty Kazahkstan
Observers
Malmö University Hospital, Sweden Health Economics and Biostatistics Mr Klas Bergenheim Lund University Department of Community Medicine
Dr Sören Höjgard Health Economics and Biostatistics Department of Community Medicine Lund University
Ms Anna Skygge WHO Intern Byggmästaregatan 8 b 222 37 Lund Sweden WHO Regional Office for Europe 8 Scherfigsvej, DK-2100 Copenhagen Ø
Ms Joy Bartrup Tel.: +45 39 171539 Assistant e-mail: [email protected]
Ms Claire Gudex (Rapporteur) Tel.: +45 39 171599 Consultant e-mail: [email protected]
Dr Herbert Zöllner (Secretary) Tel.: +45 39 171347 Regional Adviser e-mail: [email protected] Health Economics and Policy Analysis